Shared decision making with schizophrenic patients: a randomized controlled clinical trial with booster sessions...

Area of Science:

• Psychiatry
• Clinical Psychology
• Health Services Research

Background:

• Schizophrenia treatment necessitates long-term, multidimensional interventions, with antipsychotic drugs being crucial.
• Treatment adherence is paramount for effective schizophrenia management.
• Shared decision-making (SDM) involves patients in their care to enhance adherence and satisfaction, but its use in mental health is limited.

Purpose of the Study:

• To assess the efficacy of a timed SDM model, initiated before hospital discharge, in improving treatment adherence and clinical outcomes for schizophrenia patients.
• To evaluate the impact of SDM on symptom severity, hospitalization duration, and patient insight.

Main Methods:

• A single-blind, randomized clinical trial compared SDM to treatment as usual (TAU) in 102 schizophrenia patients over one year.
• The SDM group received pre-discharge sessions and regular booster sessions.
• Hierarchical multiple linear regression analyzed factors associated with adherence, controlling for covariates.

Main Results:

• The final regression model for adherence was significant (adjusted R2 = 0.384, p < 0.001).
• SDM, particularly through the number of booster sessions, showed a significant and independent association with improved adherence.
• Despite greater initial psychopathology in the SDM group, adherence was positively influenced.

Conclusions:

• Shared decision-making, augmented by booster sessions, demonstrates potential in increasing treatment adherence among patients with severe mental disorders.
• Implementing SDM is ethically, practically, and clinically supported for long-term psychiatric care, especially for schizophrenia spectrum disorders.